There’s been growing understanding around mental illness in the past few years. These days you can’t open a newspaper or switch on the TV without hearing someone talk about it — even the Royal Family are doing it.
While there is still considerable stigma and mental health continues to receive less funding and recognition than other areas of medicine, things are changing. But there is a sinister element to this new-found sympathy: people now invoke mental illness as an excuse for bad behaviour.
Consider Harvey Weinstein, the Hollywood producer at the centre of a storm of sexual assault allegations this week. No sooner had the news broke than he was claiming to be addicted to sex and checking in to an exclusive clinic.
Let’s be clear here: being a crass, offensive, misogynistic lech is not a medical condition. Sexually assaulting women is not a mental illness
This is a well-worn, PR-managed response to any indiscretion by the rich and famous.
Caught in a compromising position, pants around your ankles? Quick, get into rehab. No one will dare criticise you then because you’re unwell; it’s not your fault. In fact, you’re actually the victim here because you have a cruel illness. Poor you.
What tosh. In reality, these ‘rehab’ clinics are often little more than five-star hotels with therapists, who will nod sympathetically, tagged on.
Let’s be clear here: being a crass, offensive, misogynistic lech is not a medical condition. Sexually assaulting women is not a mental illness. Sex addiction is not a medical diagnosis. It is not a clinical condition recognised in either of the main diagnostic manuals used by psychiatrists.
No sooner had the news broke than Harvey Weinstein (pictured) was claiming to be addicted to sex and checking in to an exclusive clinic
It is a made-up condition invented to absolve the lecherous and the unfaithful from responsibility. It has been used to explain away the behaviour of selfish, wealthy, powerful men who don’t see why they should play by the same rules as the rest of us. Because once something has a label, any criticism is deemed heartless and uncaring.
In fact, the entire idea of addiction as a ‘disease’ is highly contentious within medicine. It first started being widely promoted within the medical community in the late Nineties in the U.S., where there is no free public healthcare. Some have argued that this was so health insurance companies couldn’t wriggle out of funding treatment for alcoholics.
However, the idea soon took hold over here. It was argued that although the use of substances was voluntary to start with, in some individuals it ‘flicked a switch’ in the brain that meant they could no longer stop. But a recent review published in the highly respected medical journal The Lancet Psychiatry concluded the research into addiction does not support this simplified view.
In fact, many doctors reject the idea that alcoholism and drug addiction are diseases, myself included. And that’s because it doesn’t actually help the person with the addiction.
I have spent many years working in the NHS, the charitable sector and privately with people who use drugs and alcohol. What always strikes me is how, regardless of wealth or privilege, addiction typically comes down to poor coping strategies for emotional pain and psychological distress.
Rather than being a switch that is flicked on in their brains and that they can’t shut off again, it’s that they’re using sex or alcohol, or whatever it is, as a crutch.
So calling addiction a disease is not only unhelpful, but actively counter-productive. The term removes any sense of responsibility or ownership and flies in the face of much of the psychological work that is done with addicts.
People do choose to drink alcohol or inject drugs. It is an active decision they make each day and pretending otherwise is to rob them of the fact that they can choose a different path.
The process of recovering from addiction involves taking responsibility and realising that you are the architect of your own — and often others’ — misery.
You can’t cure bad parenting with a pill
ADHD — a psychiatric condition characterised by difficulties with attention, hyperactivity and impulsiveness — is in the news again after published research showed that younger children in a class were significantly more likely to be diagnosed with the condition.
Experts argued this seemed to suggest that greater immaturity could be what was driving the diagnosis, as parents and teachers misattribute their difficulties to ADHD.
ADHD — a psychiatric condition characterised by difficulties with attention, hyperactivity and impulsiveness — is in the news again after published research showed that younger children in a class were significantly more likely to be diagnosed with the condition
For me, this further highlights why we need to approach a diagnosis of ADHD with great caution in children and consider if other factors could be contributing to their symptoms.
I feel very uneasy that so many children are given this label — and prescribed drugs such as Ritalin accordingly.
The World Health Organisation states that a diagnosis of ADHD can represent family dysfunction or inadequacies, rather than a problem with the child, and it’s this that worries me.
It’s easy to whack on a label and medicalise their behaviour rather than to accept, however uncomfortably, that it might be a problem with the parenting.
I say this not to blame parents, but to question how medicalising a child’s bad and disruptive behaviour really helps them.
Yes, it’s difficult to unpick complicated family dynamics that contribute to disruptive behaviour. But by taking the easy option and giving children — whose tender brains are still developing — behaviour-altering drugs, are we not letting down an entire generation by neglecting to look in to what’s really causing it?
Throwing cash at GPs just won’t help
GP vacancy rates are at record levels, with one in eight posts empty and increasing numbers of practices finding it simply impossible to recruit. Latest figures show one million patients a week are unable to get an appointment, with one in five waiting at least a week to see a GP — a 56 per cent rise in five years.
This week, Health Secretary Jeremy Hunt revealed plans to give GPs a ‘golden hello’ of £20,000 in a bid to encourage them to work in parts of the country struggling to recruit. While something has to be done, and quickly, I’m not convinced a cash bung is going to solve the crisis. After all, what’s to stop them taking the money and leaving soon after?
This problem is not new. When the NHS was introduced, GPs had to be redistributed from affluent towns to areas that needed them most. Financial incentives were offered, but it soon became apparent they were not the answer and did not attract the best candidates.
Instead, it was noted that ‘the good doctor will only be attracted into industrial practice by providing conditions which will enable him to do good work’. In other words, for a post to be appealing, the area has to have the adequate infrastructure and resources to enable them to practise medicine effectively.
Therefore, perhaps the cash would be better spent on improving resources in deprived areas, which would not only make working there more appealing, but would benefit the whole community.
The other factor was the background of doctors. Then, as now, medicine tended to attract people from affluent towns who, after qualifying, returned home.
Despite attempts to increase access to higher education, for the most part a degree in medicine remains the preserve of the wealthy — it is a long course and, therefore, financially more prohibitive.
Careful investment and support in deprived communities is what’s needed — not just throwing more cash at GPs.
Being lonely can be as bad for someone’s health as having a long-term illness such as diabetes, or so said the Royal College of General Practitioners this week.
For me, this emphasises that we are social animals. I worry that as the traditional family unit has broken down and families live further apart, more and more people are living isolated lives, particularly the elderly. But we can all help. Why should it be down to doctors or social workers to find ways of tackling such loneliness?
I remember an elderly patient I had a few years ago. She was withdrawn, unkempt and depressed. I struggled to know what to do to help her. In desperation, I referred her to a befriending service run by a charity. A volunteer started popping in once a week for tea and a chat.
Over the next few months, she was transformed. She began doing her hair, seemed brighter and even started smiling again. There’s no pill that could have achieved that.
DrMax@dailymail.co.uk